Connection of an endovascular intervention device to a manipulation member

ABSTRACT

A device for intravascular intervention can comprise an intervention element, an elongate manipulation member, and a joining element. The elongate member can comprise a hooked portion extending about a proximal portion of the intervention element. The joining element can substantially permanently attach the hooked portion to the intervention element.

RELATED APPLICATION

This application claims the benefit of U.S. Provisional Application No.61/750,742, entitled “CONNECTION OF A MANIPULATION MEMBER TO ANENDOVASCULAR INTERVENTION DEVICE,” filed Jan. 9, 2013, the entirety ofwhich is expressly incorporated herein by reference.

BACKGROUND

A variety of procedures can be performed by manipulating an endovascularintervention device connected to a manipulation member, such as, forexample, a wire or hypotube. In some instances, endovascular devices canbe manipulated by a practitioner from a location outside the body usingthe manipulation member. Thus, the manipulation member may extend from alocation outside the body to a treatment location within the body. Themanipulation member may extend through a catheter from the locationoutside the body to the treatment location. Endovascular interventiondevices can be connected to manipulation members in a variety of ways.

SUMMARY

An aspect of at least one embodiment disclosed herein includes therealization that a need exists for connections, between endovascularintervention devices and manipulation members, that (i) have a maximumcross-sectional dimension that is small enough to be introduced througha catheter having a small inner diameter, (ii) are more reliable, and,(iii) in the event of failure, fail in a desired mode. Such cathetersmay be microcatheters that are suitable for neurovascular intervention,and may have inner diameters that are, for example, 0.027 inch, 0.021inch, or smaller.

The subject technology is illustrated, for example, according to variousaspects described below. Various examples of aspects of the subjecttechnology are described as numbered clauses (1, 2, 3, etc.) forconvenience. These are provided as examples and do not limit the subjecttechnology. It is noted that any of the dependent clauses may becombined in any combination, and placed into a respective independentclause, e.g., clause 1 or clause 5. The other clauses can be presentedin a similar manner.

1. A device for intravascular intervention, the device comprising:

-   -   an intervention element;    -   an elongate manipulation member comprising a hooked portion        extending about a proximal portion of the intervention element;        and    -   a joining element substantially permanently attaching the hooked        portion to the intervention element.

2. The device of Claim 1, wherein the joining element comprises a bandthat substantially surrounds at least a section of the elongate memberand a segment of the intervention element.

3. The device of Claim 1, further comprising a binding agent engagingeach of the intervention element, the elongate member, and the joiningelement.

4. The device of Claim 3, wherein the binding agent is a UV curableadhesive.

5. A device for intravascular intervention, the device comprising:

-   -   an elongate manipulation member comprising a distally-located        attachment portion, the attachment portion comprising a first        segment, a second segment, and a bend between the first and        second segments;    -   an intervention element comprising a proximal end portion and a        hole through the proximal end portion, the attachment portion of        the elongate member extending through the hole at the bend such        that the first segment and the second segment are located on        different sides of the proximal end portion, the intervention        element being substantially permanently attached to the elongate        delivery member.

6. The device of Claim 5, further comprising a band, wherein the bandsubstantially surrounds at least a section of the attachment portion ofthe elongate member and a segment of the proximal portion of theintervention element.

7. The device of Claim 6, wherein the band has an inner diameter that isless than a width of the proximal end portion of the interventionelement.

8. The device of Claim 6, wherein the band does not extend over the tab.

9. The device of Claim 6, wherein the band is crimped onto each of theelongate member and the intervention element.

10. The device of Claim 9, wherein the band is crimped onto a retentionportion of the intervention element, the retention portion beingpositioned between the hole and a terminal proximal end of theintervention element.

11. The device of Claim 9, wherein the proximal end portion of theintervention element comprises a shoulder positioned laterally of theretention portion, the shoulder extending laterally to an extent,measured from the retention portion, that is greater than or equal to awall thickness the band.

12. The device of Claim 9, wherein the retention portion comprises aproximal part and a middle part, the middle part being located betweenthe hole and the proximal part, and the proximal part having a widthgreater than a width of the middle part.

13. The device of Claim 9, wherein the proximal end portion of theinterventional element has a top side and a bottom side, the holeextends through the proximal end portion between the top side and thebottom side, and the retention portion extends laterally beyond theattachment portion of the elongate member as viewed from the top.

14. The device of Claim 13, wherein, as viewed from the top of theproximal end portion of the intervention element, the retention portionis laterally offset from the attachment portion of elongate member.

15. The device of Claim 14, wherein, as viewed from the top of theproximal end portion of the intervention element, the proximal part ofthe retention portion underlies the attachment portion of elongatemember and the middle part of the retention portion does not underliethe attachment portion.

16. The device of Claim 15, wherein at least one of the first segment orthe second segment of the elongate member has an extending portion thatextends into a region that is (i) between the top side and the bottomside of the proximal end portion, and (ii) between the proximal part ofthe retention portion and the hole, the extending portion and theproximal part being aligned such that a line extending in aproximal-distal direction intersects the extending portion and theproximal part.

17. The device of Claim 6, wherein the band is circumferentiallycontinuous.

18. The device of Claim 6, wherein the band is radiopaque.

19. The device of Claim 6, wherein the band is circumferentiallydiscontinuous and comprises first and second lateral edges, the bandhaving first and second portions adjacent the first and second edges,respectively, that overlap each other.

20. The device of Claim 5, further comprising a binding agent attachedto the elongate member and the intervention element.

21. The device of Claim 20, further comprising a band, wherein the bandsubstantially surrounds the distal portion of the elongate member and aportion of the proximal end of the intervention element.

22. The device of Claim 20, wherein the binding agent comprises anadhesive.

23. The device of Claim 22, wherein the adhesive is UV curable.

24. The device of Claim 5, wherein the first segment and the secondsegment extend generally parallel to each other.

25. The device of Claim 24, wherein the elongate manipulation memberfurther comprises a proximal terminal end and a distal terminal end, andthe distal terminal end is proximal of the bend of the attachmentportion.

26. A method of using a device, the device comprising an interventionelement, an elongate manipulation member comprising a distally-locatedhooked attachment portion extending about a proximal portion of theintervention element, and a joining element substantially permanentlyattaching the attachment portion to the intervention element, the methodcomprising:

-   -   inserting the intervention element into a cerebral blood vessel        using the elongate member;    -   manipulating the device to perform a therapy;    -   removing the intervention element from the cerebral blood vessel        using the elongate member.

27. The method of Claim 26, wherein:

-   -   the hooked attachment portion comprises a first segment, a        second segment, and a bend between the first and second        segments;    -   the intervention element comprises a hole through the proximal        portion; and    -   the attachment portion extending through the hole at the bend        such that the first segment and the second segment are located        on different sides of the proximal portion.

28. The method of Claim 26, wherein the device is inserted through amicrocatheter.

29. The method of Claim 26, wherein the removing is performed byproximally pulling the elongate member such that the interventionelement is retracted into a microcatheter.

30. The method of Claim 26, wherein the manipulating comprises deployingthe intervention element to an expanded position.

31. The method of Claim 30, wherein the deploying comprisessubstantially maintaining a location of the intervention element whileretracting a microcatheter from over the intervention element.

32. The method of Claim 30, wherein the manipulating further comprisesrestoring blood flow through an obstructed portion of the cerebral bloodvessel.

33. The method of Claim 30, wherein the manipulating further comprisescapturing a thrombus.

34. The method of Claim 33, wherein the removing the interventionelement comprises removing the captured thrombus from the cerebral bloodvessel.

35. A device for intravascular intervention, the device comprising:

-   -   an intervention element;    -   an elongate manipulation member comprising a hooked portion        extending about a proximal portion of the intervention element,        the hooked portion comprising a bend, the hooked portion        having (i) no substantial surface crack at an interior region of        the bend and (ii) a maximum lateral dimension that is less than        0.027 inch; and    -   a joining element substantially permanently attaching the hooked        portion to the intervention element.

36. The device of Claim 35, wherein the hooked portion comprises nosurface crack that is (i) at the bend and (ii) discernable, by a normalhuman eye, under 10× magnification.

37. The device of Claim 36, wherein the bend has a radius that is lessthan double a maximum cross-sectional dimension of the elongate memberin the bend.

38. The device of Claim 37, wherein the bend has a radius that is lessthan the maximum cross-sectional dimension of the elongate member in thebend.

39. The device of Claim 35, wherein the maximum lateral dimension isless than 0.021 inch.

40. The device of Claim 39, wherein the maximum lateral dimension isless than 0.015 inch.

41. The device of Claim 35, wherein the hooked portion comprises nosurface crack at the bend.

42. The device of Claim 35, wherein the hooked portion comprises nosurface crack at an exterior region of the bend.

43. The device of Claim 35, wherein the elongate member has a maximumcross-sectional dimension that is less than 0.007 inch along the hookedportion.

44. The device of Claim 35, wherein the joining element comprises a bandthat substantially surrounds at least a section of the elongate memberand a segment of the intervention element.

45. The device of Claim 35, further comprising a binding agent engagingeach of the intervention element, the elongate member, and the joiningelement.

46. A device for intravascular intervention, the device comprising:

-   -   an elongate manipulation member comprising a distally-located        attachment portion, the attachment portion comprising a first        segment, a second segment, and a bend, without any substantial        surface crack, located between the first and second segments,        the attachment portion having a maximum lateral dimension that        is less than 4 times a maximum cross-sectional dimension of the        elongate member along the attachment portion;    -   an intervention element comprising a proximal end portion and a        hole through the proximal end portion, the attachment portion of        the elongate member extending through the hole at the bend such        that the first segment and the second segment are located on        different sides of the proximal end portion, the intervention        element being substantially permanently attached to the elongate        delivery member.

47. The device of Claim 46, wherein the hooked portion comprises nosurface crack that is (i) at the bend and (ii) discernible, by a normalhuman eye, under 10× magnification.

48. The device of Claim 47, wherein the bend has a radius that is lessthan double a maximum cross-sectional dimension of the elongate memberin the bend.

49. The device of Claim 48, wherein the bend has a radius that is lessthan the maximum cross-sectional dimension of the elongate member in thebend.

50. The device of Claim 46, wherein the hooked portion has a maximumlateral dimension that is less than 0.07 mm.

51. The device of Claim 50, wherein the maximum lateral dimension isless that 0.05 mm.

52. The device of Claim 51, wherein, the maximum lateral dimension isless than 0.04 mm.

53. The device of Claim 46, further comprising a band, wherein the bandsubstantially surrounds at least a section of the attachment portion ofthe elongate member and a segment of the proximal portion of theintervention element.

54. The device of Claim 46, further comprising a binding agent attachedto the elongate member and the intervention element.

55. The device of Claim 54, further comprising a band, wherein the bandsubstantially surrounds the distal portion of the elongate member and aportion of the proximal end of the intervention element.

56. The device of Claim 46, wherein the first segment and the secondsegment extend generally parallel to each other.

57. The device of Claim 56, wherein the elongate manipulation memberfurther comprises a proximal terminal end and a distal terminal end, andthe distal terminal end is proximal of the bend of the attachmentportion.

58. The device of Claim 46, wherein the elongate member is metallic.

59. The device of Claim 46, wherein the elongate member comprises nickeltitanium alloy.

60. The device of Claim 46, wherein the elongate member furthercomprises a polymer coating over at least a portion thereof.

61. A method of using a device, the device comprising an interventionelement, an elongate manipulation member comprising a distally-locatedhooked attachment portion extending about a proximal portion of theintervention element, the attachment portion comprising a first segment,a second segment, and a bend between the first and second segments, thebend having no substantial surface crack, the attachment portion havinga maximum lateral dimension that is less than 4 times a maximumcross-sectional dimension of the elongate member along the attachmentportion, and a joining element substantially permanently attaching theattachment portion to the intervention element, the method comprising:

-   -   inserting the intervention element into a cerebral blood vessel        using the elongate member;    -   manipulating the device to perform a therapy;    -   removing the intervention element from the cerebral blood vessel        using the elongate member.

62. The method of Claim 61, wherein:

-   -   the intervention element comprises a hole through the proximal        portion; and    -   the attachment portion extending through the hole at the bend        such that the first segment and the second segment are located        on different sides of the proximal portion.

63. The method of Claim 61, wherein the device is inserted through amicrocatheter.

64. The method Claim 61, wherein the removing is performed by proximallypulling the elongate member such that the intervention element isretracted into a microcatheter.

65. The method of Claim 61, wherein the manipulating comprises deployingthe intervention element to an expanded position.

66. The method of Claim 65, wherein the deploying comprisessubstantially maintaining a location of the intervention element whileretracting a microcatheter from over the intervention element.

67. The method of Claim 65, wherein the manipulating further comprisesrestoring blood flow through an obstructed portion of the cerebral bloodvessel.

68. The method of Claim 65, wherein the manipulating further comprisescapturing a thrombus.

69. The method of Claim 68, wherein the removing the interventionelement comprises removing the captured thrombus from the cerebral bloodvessel.

Additional features and advantages of the subject technology will be setforth in the description below, and in part will be apparent from thedescription or may be learned by practice of the subject technology. Theadvantages of the subject technology will be realized and attained bythe structure particularly pointed out in the written description andclaims hereof as well as the appended drawings.

It is to be understood that both the foregoing general description andthe following detailed description are exemplary and explanatory and areintended to provide further explanation of the subject technology asclaimed.

BRIEF DESCRIPTION OF THE DRAWINGS

The accompanying drawings, which are included to provide furtherunderstanding of the subject technology and are incorporated in andconstitute a part of this description, illustrate aspects of the subjecttechnology, and, together with the specification, serve to explainprinciples of the subject technology.

FIG. 1 is a schematic illustration of an exemplifying assembly forendovascular intervention according to some embodiments.

FIG. 2 is a perspective view of connection between a manipulation memberand an endovascular intervention device according to some embodiments.

FIG. 3 is a bottom view of the connection of FIG. 2.

FIG. 4 is a side view of the connection up FIGS. 2 and 3.

FIG. 5 is a cross-sectional view of the connection up FIGS. 2-4 alongthe line 5-5 shown in FIG. 3.

FIG. 6 is a side view of an assembly for endovascular intervention andshows a manipulation member comprising a plurality of componentsaccording to some embodiments.

FIG. 7 is a high-magnification image of a wire comprising a substantialsurface crack at a bend in the wire.

FIG. 8 is a high-magnification image of a wire comprising substantialsurface cracks at a bend in the wire.

FIG. 9 is a high-magnification image of a wire comprising no substantialsurface crack at a bend in the wire.

FIG. 10 is another image of the wire of FIG. 9 at a higher magnificationthan the image of FIG. 9.

FIG. 11 is a high-magnification image of a wire comprising nosubstantial surface crack at a bend in the wire.

FIG. 12 is another image of the wire of FIG. 11 at a highermagnification than the image of FIG. 11.

FIG. 13 is a top view of a proximal end portion of an endovascularintervention device according to some embodiments.

FIG. 13A is a top view of the proximal end portion, as shown in FIG. 13,a distal end portion of a wire, and a band, according to someembodiments. In FIG. 13A, the band is shown in cross-section.

FIG. 14 is a perspective view of a wire bending apparatus according tosome embodiments.

FIG. 15 is a front perspective of the wire bending apparatus of FIG. 14,showing the apparatus performing a bending operation.

FIGS. 16-20 are schematic illustrations of method steps for performingan exemplifying endovascular procedure of restoring blood flow in anobstructed blood vessel using the assembly for endovascular interventionof FIG. 1.

DETAILED DESCRIPTION

In the following detailed description, specific details are set forth toprovide an understanding of the subject technology. It will be apparent,however, to one ordinarily skilled in the art that the subjecttechnology may be practiced without some of these specific details. Inother instances, well-known structures and techniques have not beenshown in detail so as not to obscure the subject technology.

FIG. 1 is a schematic illustration of an exemplifying assembly 100 forendovascular intervention, according to some embodiments. The assembly100 illustrated in FIG. 1 comprises an endovascular device 102 and amanipulation member 104 joined at a connection 106. The assembly 100 isillustrated as extending out of a distal end of a catheter 108.

The endovascular device 102 can comprise an element for performing anendovascular intervention. The endovascular device 102 can comprise astent-like device, as illustrated and FIG. 1. In some embodiments, theendovascular device 102 can comprise other types of endovasculardevices. The endovascular device 102 can comprise devices configured forvarious purposes, such as, for example, aneurysm bridging or treatmentof ischemic stroke. The endovascular device 102 can comprise devicessuch as those disclosed in any of U.S. Pat. No. 7,300,458, entitledMedical Implant Having a Curable Matrix Structure, issued Nov. 27, 2007;U.S. Patent Application Publication No. 2011/0060212, entitled Methodsand Apparatus for Flow Restoration, published on Mar. 10, 2011; U.S.Patent Application Publication No. 2012/0083868, entitled Methods andApparatuses for Flow Restoration and Implanting Members in the HumanBody, published on Apr. 5, 2012; and U.S. Patent Application PublicationNo. 2011/0160763, entitled Blood Flow Restoration in Thrombus ManagementMethods, published on Jun. 30, 2011; each of which is herebyincorporated by reference in its entirety.

The endovascular device 102 and the manipulation member 104 can besubstantially permanently attached together at the connection 106. Thatis, the endovascular device 102 and the manipulation member 104 can beattached together in a manner that, under the expected use conditions ofthe assembly 100, the endovascular device and the manipulation memberwould not become unintentionally separated from one another. In someembodiments, the assembly 100 can comprise a portion, located proximallyor distally of the connection 106, that is configured for selectivedetachment of the endovascular device 102 from the manipulation member104. For example, such a portion can comprise an electrolyticallyseverable segment of the manipulation member. In some embodiments, theassembly 100 can be devoid of any feature that would permit selectivedetachment of the endovascular device 102 from the manipulation member104.

FIGS. 3-5 illustrate a connection 106, according to some embodiments,between a manipulation member 104 and an endovascular device 102. Asillustrated in FIG. 2, the connection 106 can comprise an attachmentportion 110 of the manipulation member 104, a proximal portion 112 ofthe endovascular device 102, and one or more joining members, such as aband 114, a bonding agent 116, or both. The connection 106 can bedimensioned to fit through a catheter for delivery to a treatmentlocation within the body of a patient. In some embodiments, theconnection 106 can be dimensioned fit through a microcatheter suitablefor delivery into the neurovasculature. For example, the microcathetercan have an inner diameter of 0.027 inch or less, such as 0.021 inch,for example.

FIG. 6 is a schematic illustration of an assembly 100 for endovascularintervention and shows a manipulation member 104, according to someembodiments, comprising a plurality of components. As illustrated inFIG. 6, the manipulation member 104 can comprise a wire 118, a coil 120,and one or more tubes 122.

The wire 118 can have a length sufficient to extend from a locationoutside the patient's body through the vasculature to a treatment sitewithin the patient's body. The wire 118 can be monolithic or formed ofmultiple joined segments, in some embodiments. The wire 118 can compriseor consist of nickel titanium alloy. In embodiments that comprisemultiple joined segments, the segments may be of the same or differentmaterials. For example, some or all of the wire 118 can be formed ofstainless steel, or other suitable materials known to those skilled inthe art. Nickel titanium alloy may be preferable for kink resistance andreduction of imaging artifacts.

As illustrated in FIG. 6, the wire 118 can taper between a proximal end124 and a distal end 126. The wire 118 can have a larger diameter at theproximal end 124 than at the distal end 126. The wire 118 can tapercontiguously or in spaced increments along all or a portion of itslength. As illustrated in FIG. 5, the wire 118 can taper at theattachment portion 110. Any tapering portion of the wire 118 can taperat a constant rate or at a variable rate per unit length. The attachmentportion 110 can taper from a diameter of approximately 0.0065 inch, at alocation just proximal to the connection 106, to approximately 0.0045inch, at the terminal and the wire 118. In some embodiments, wire 118can have a diameter of approximately 0.007 inch along the attachmentportion 110.

The coil 120 (FIG. 6) can be comprised of a radiopaque material suchthat the coil 120 can serve as a marker. Additionally or alternatively,a length, a diameter, and a pitch of the coil can be selected to providedesired flexibility and pushability to the manipulation member 104. Themanipulation member 104 can further comprise a marker locatedapproximately 120 cm from a distal end of the wire. The marker can befluorosafe and approximately 1 inch long.

The tubes 122 can be formed of polymer materials. In some embodiments,the tubes can comprise a polymer material that shrinks whenappropriately heated.

Referring again to FIGS. 2-5, the attachment portion 110 can comprise afirst segment 130, the second segment 132, and a bend 134 between thefirst and second segments. In some embodiments, the attachment portion110 can form a hook, as illustrated in FIG. 5, for example. One or bothof the first segment 130 and the second segment 132, in the assembly 100for endovascular intervention, can be substantially straight or curved,as illustrated in FIG. 5. In some embodiments, the first segment 130 andthe second segment 132 can be generally parallel to each other. Asillustrated in FIGS. 2-5, a distal terminal end of the manipulationmember 104 can be located proximally of the bend 134 in the assembly100. In some embodiments, the attachment portion 110 can comprise a bendof approximately 180°.

In some embodiments, the wire 118 can have a nominal diameter of 0.0055inch at the bend of the attachment portion 110. In some embodiments, thewire 118 has a circular cross-section prior to being bent, and an ovoidcross-section after being bent.

In some embodiments, the bend 134 can have a radius that is less thandouble a maximum cross-sectional dimension, e.g., diameter, of themanipulation member 104 in the bend. In some embodiments, the bend 134can have a radius that is less than a maximum cross-sectional dimension,e.g., diameter, of the manipulation member 104 in the bend. In someembodiments, the bend radius can vary through the bend.

The attachment portion 110 can have a maximum lateral dimension that ismeasured in a direction perpendicular to a longitudinal axis, extendingin a proximal-distal direction, of the assembly 110. In someembodiments, the maximum lateral dimension is less than 0.027 inch, lessthan 0.021 inch, or less than 0.015 inch. In some embodiments, themaximum lateral dimension is less than 0.07 mm, less than 0.05 mm, orless than 0.04 mm. In some embodiments, the maximum lateral dimension isless than four times a maximum cross-sectional dimension, e.g.,diameter, of the wire 118 along the attachment portion 110. In someembodiments, the maximum lateral dimension is less than 0.07 mm, lessthan 0.05 mm, or less than 0.04 mm. In some embodiments, the maximumlateral dimension is less than three times a maximum cross-sectionaldimension, e.g., diameter, of the wire 118 along the attachment portion110.

In some embodiments, the attachment portion 110 can comprise nosubstantial surface crack along or at an interior region, an exteriorregion, or both of the bend 134. Each of FIGS. 7 and 8 show wires thatcomprise a substantial surface crack at an interior region of a bend.FIGS. 9 and 10 show a wire without any substantial surface crack at abend. FIGS. 11 and 12 show another wire without any substantial surfacecrack at a bend. Each of the wires shown in FIGS. 7-12 has a diameter of0.0045 inch and is made of Nitinol. The images of FIGS. 7 and 8 werecaptured under 540× and 340× magnification, respectively. The images ofFIGS. 9 and 11 were captured under 270× magnification. The images ofFIGS. 10 and 12 were captured under 500× magnification. A surface crackis herein considered substantial it is visually discernible, by a normalhuman eye, under 10× magnification. For example, a crack that cannot beseen under 10× magnification by a person with 20/20 vision isinsubstantial.

FIG. 13 is a top view of the proximal portion 112 of an endovasculardevice 102. The proximal portion 112 can be formed of any of nickeltitanium alloy, stainless steel, or other materials suitable forintroduction into the body for endovascular intervention. The proximalportion 112 can be configured such that the attachment portion 110 ofthe manipulation member 104 can extend around a part of the proximalportion 112. For example, the proximal portion 112 can comprise aopening 136, such as a hole or slot, therethrough.

The opening 136 shown in FIG. 13 is sized and shaped to permit the bend134 of the attachment portion 110 to extend therethrough. For example,the opening 136 can be slightly larger than the cross-section of theattachment portion 110 that extends through the hole. The opening 136can be ovoid, as illustrated in FIG. 13, for example. The hole or slotcan be located proximate a proximal terminal end of the endovasculardevice 102.

The proximal portion 112 of the endovascular device 102 can comprise aretention portion 138 positioned proximally of the opening 136. Theretention portion 138 can be offset from a line 143 that extends througha center of a region of the opening 136 where the attachment portion 100resides in the assembly 100. The retention portion 138 can be offset ina lateral direction, i.e., in a direction perpendicular to a lineextending in a proximal-distal direction, by a distance sufficient topermit at least a portion of the retention portion to extend laterallybeyond the manipulation member 104. In some embodiments, the distance oflateral offset can be one half of the transverse dimension of themanipulation member, e.g., one half of the width or diameter of themanipulation member, or greater. In some embodiments, the distance oflateral offset can be about one half of the transverse dimension of themanipulation member. In some embodiments, the lateral offset can permita band 114 to be crimped directly onto the retention portion 138 asdiscussed further below. In FIG. 13, a region 144 indicates the laterallocation of the attachment portion 110 in the assembly 100. As can beseen in FIG. 13A, the retention portion 138 extends laterally beyond theattachment portion 110 in a top view.

The retention portion 138 can comprise a proximal part 140 and a middlepart 142. The middle part 142 can be positioned between the proximalpart 140 and the opening 136. The middle part can be configured suchthat it does not underlie the attachment portion 110 of the manipulationmember 104 in the assembly 100. For example, the middle part 142 doesnot extend into the region 144, representing a straight and centrallylocated attachment portion 110, in FIG. 13. The proximal part 140 can beconfigured such that it underlies at least a portion of the attachmentportion 110 in the assembly 100. For example, the proximal portion 140extends into the region 144, representing a straight and centrallylocated attachment portion 110, in FIG. 13. In some embodiments whereinthe proximal portion 140 extends into the region 144 and the middleportion 142 does not extend into the region 144, one or both of thefirst segment 130 and the second segment 132 of the attachment portion110 can extend into a space located (a) between the proximal part 140and the opening 136 and (b) between a top surface and a bottom surfaceof the retention portion 138.

In some embodiments, the retention portion 138 can have a lengthsufficient to permit, or facilitate, deformation of a portion of themanipulation member 104 into the region 144. In some embodiments, theretention portion 138 can extend proximally a distance sufficient toallow manipulation of the retention portion 138 while the endovasculardevice 102 is positioned within the cerebral vasculature and theretention portion 138 extends through an access catheter. In someembodiments, the retention portion 138 can extend proximallyindefinitely.

As illustrated in FIG. 13 for example, the proximal portion 112 of theendovascular device 102 can comprise a shoulder 145 positioned laterallyof the retention portion 138. The shoulder can extend laterally to anextent, measured from the retention portion, that is greater than a wallthickness of the band 114. For example, the shoulder 145 can extend fromthe retention portion 138 by a distance X, as illustrated in FIG. 13,that is greater than or equal to a wall thickness of the band 114.

In some embodiments, the proximal portion 112 of the endovascular device102 can have a substantially constant thickness, such as would resultfrom the endovascular device being cut from a tube or sheet of material,for example. In other embodiments, the thickness of the proximal portion112 can vary across its length, width, or both.

As noted above, the connection 106 can comprise a band 114 in someembodiments, as illustrated in FIGS. 2-5, for example. In someembodiments, comprising a band 114, the band can hold the attachmentportion 110 against the retention portion 138. Additionally oralternatively, the band can serve as a radiopaque marker. In someembodiments, the band 114 can hinder separation of the attachmentportion 110 from the retention portion 138. In some embodiments, theband 114 can be crimped onto one or both of the attachment portion 110and the retention portion 138. In some embodiments, the band can becrimped onto each of the attachment portion 110 and the retentionportion 138. In embodiments wherein band serves as a radiopaque marker,crimping the band directly to the retention portion 138 can retain themarker band on the retention portion 138 in the unlikely event ofunintentional separation of the manipulation member 104 from theendovascular device 102.

The band 114 can surround all or a portion of the length of theattachment portion 110, the retention portion 138, or both in theassembly 100. In some embodiments, the band 114 does not extend over atleast a part of the proximal portion 112 of the endovascular device 132.For example, in some embodiments, the band 114 does not surround a part,of the proximal portion, that surrounds the opening 136.

The band 114 can be a sleeve that is circumferentially continuous.Alternatively, the band 114 can be circumferentially discontinuous andcan have lateral edges that overlap when the band is attached at theconnection 106. In some embodiments, a clip that only partiallysurrounds all or a portion of the length of the attachment portion 110,the retention portion 138, or both in the assembly 100 can be used inaddition or alternative to the band 114. In some embodiments, the bandor clip completely or substantially surrounds at least a section of theattachment portion 110 and a segment of the retention portion 138.

In embodiments wherein the band or clip serves as a marker, the band orclip can be formed of a radiopaque material such as, for example,platinum or platinum alloys, including platinum-iridium. In someembodiments, the band or clip can be formed of a non-radiopaquematerial.

The band 114 can have a maximum cross-sectional (lateral) dimension thatis 0.027 inch or less, 0.021 inch or less, or 0.015 inch or less, insome embodiments. The band 114 can have an outer diameter of 0.015 inchprior to attachment at the connection 106, and a maximum cross-sectionaldimension of 0.006 inch after being crimped at the connection 106. Theband 114 can have cross-sectional dimension(s) that inhibit or preventmovement of the band distally over the proximal portion 112 of theendovascular device 102. For example, the cross-sectional dimension canbe a diameter (inner or outer) that is less than a width of the proximalportion 112. FIG. 13A illustrates an embodiment wherein thecross-sectional dimension of the band 114, before any crimping, is lessthan a width of the proximal portion 112.

The connection 106 can comprise a binding agent 116 in addition oralternative to the band 114 in some embodiments. The binding agent canstrengthen the connection 106 between the endovascular device 10 to themanipulation member 104, and hindering separation of the attachmentportion 110 from the retention portion 138. The binding agent 116 canbond each of the attachment portion 110 and the retention portion 138.The binding agent 116 can comprise adhesive, solder, welding flux,brazing filler, etc. In some embodiments, the binding agent can bond tothe attachment portion 110 in the retention portion 138 without applyingheat. For example, the binding agent can comprise a UV-curable adhesive,such as product no. 1128A-M-T of Dymax Corp. (Torrington, Conn.). Inembodiments that comprise a polymer coating of the wire or polymertubing, use of a binding agent that avoids application of heat thatwould damage the polymer may be preferred.

As illustrated in FIGS. 2-5, the binding agent 116 can cover the bend134 of the attachment portion 110, a proximal end of the connection 106,or both. In embodiments that comprise a band 114 and binding agent 116,the binding agent can fill all or a portion of an interior volume of theband in addition or alternative to covering one or both ends of theconnection 106. In some embodiments, the wire 118 tapers at anintersection with the binding agent 116. Tapering of the wire at theintersection with the binding agent can concentrate stress at theintersection to promote breakage at the intersection in the event thatthe wire 118 breaks, thereby retaining the band 114 on the endovasculardevice 102. Retention of the band on the endovascular device may bedesirable in embodiments wherein band serves as a marker.

In some embodiments, the manipulation member 104 can be attached to theendovascular device 102 at the connection 106 by the processes describedbelow and variants thereof. The attachment portion 110 of themanipulation member 104 can be positioned about a part of the proximalportion 112 of the endovascular device 102. For example, a distal endportion of the wire 118 can be passed through the opening 136. Theattachment portion 110 of the manipulation member 104 can extend throughthe opening 136 at the bend 134 such that the first segment 130 and thesecond segment 132 are on different sides of the proximal portion 112 ofthe endovascular device 102. In some embodiments, the terminal distalend of the wire 118 can be located proximally of the bend 134. In someembodiments, the wire 118 can be bent to interlock with the proximalportion 112 of the endovascular device 102.

In some embodiments wherein the manipulation member 104 comprises aplurality of components, the components of the manipulation member canbe assembled together prior to attachment of the manipulation member tothe endovascular device 102. For example, in some embodiments, a wire118, a coil 120, and one or more tubes 122 can be assembled together, asillustrated in FIG. 6 for example, before a portion of the wire 118 ispassed through the opening 136 in the proximal portion 112 of theendovascular device 102, before the wire 118 is bent, or both.

The wire 118 can be bent in one or more stages between an initialstraight configuration and a final configuration in the completedassembly 100. For example, the wire 118 can be bent by an initial amountbefore any portion of the wire is passed through the opening 136 andbent a further amount thereafter. The wire can be initially bent between10° and 170°, between 45° and 160°, between 90° and 145°, or between125° and 135°, from a straight configuration, prior to any portionthereof being passed through the opening 136. After segment of the wirehas been passed through the opening 136, the wire can be bent by afurther amount to accommodate the band 114, if present. In someembodiments wherein the connection 106 includes a band 114 and the bandis crimped, the wire can be bent by an additional amount. In someembodiments, the wire can be finally bent to between 150° and 210°,between 160° in 200°, or between 170° and 190°. Preferably, the finalbend 134 has no substantial surface crack.

If the band 114 cannot be positioned over the attachment portion 110without further deflection of the wire, the wire can be bent, or furtherbent, to accommodate the band 114. In some embodiments, the band 114 canbe positioned over the manipulation member 104 or the endovasculardevice 102 prior to coupling the manipulation member and theendovascular device. The band 114 can be positioned around all or aportion of the attachment portion 110 and all or a portion of theretention portion 138 by moving the band and a proximal or distaldirection. In some embodiments, the band 114 is moved over themanipulation member 104 in a distal direction and, as the band isadvanced onto the attachment portion 110, a terminal distal end of thewire can be deflected to enter an interior of the band. Then, the wirecan be further bent as the band is advanced farther distally, andoptionally with the terminal distal end of the wire being heldstationary.

With the band 114 positioned around all or a portion of the attachmentportion 110 and all or a portion of the retention portion 138, the bandcan be crimped directly onto one or both of the attachment portion andthe retention portion. In some embodiments, crimping the band directlyto each of the attachment portion the retention portion can hinderundesired separation of them during use. The band can be crimped byapplying inwardly directed pressure at multiple locations 146 (FIGS.2-5) around an exterior of the band. For example, band can be crimped byapplying pressure at two, three, four, or more locations around theband.

The locations 146 where pressure is applied to crimp the band can bespaced evenly or unevenly around the circumference of the band. Thelocations 146 can be selected such that the band is crimped directlyonto the attachment portion 110, the retention portion 138, or both. Insome embodiments, the locations 146 can be selected such that the firstsegment 130, the second segment 132, or both are urged into a regionthat is (i) adjacent to the middle part 142 of the retention portion and(ii) between the proximal part 140 and the opening 136, as discussedabove. When the band 114 is crimped directly to the retention portion138, locations 146 may be selected on either side of the retentionportion 138 such that the proximal part 140, the middle part 142, orboth are at least partially trapped by the band 114. When the band 114is crimped directly to the attachment portion 110, locations 146 may beselected on opposing sides of the first segment 130, the second segment132, or both such that at least a portion of one or both of the firstand second segments is trapped by the band 114.

In embodiments that comprise a bonding agent, the bonding agent 116 canbe applied to the attachment portion 110 of the manipulation member 104and the proximal portion 112, e.g., at the retention portion 138, of theendovascular device 102 after a segment of the manipulation member hasbeen positioned about the proximal portion 112. If the connection 106comprises a band 114 and bonding agent 116, the bonding agent can beapplied at the connection 106 before or after the band 114 is attachedat the connection 106. If the terminal distal end of the wire 118extends proximally beyond a proximal end of the band 114, the wire 118can be trimmed so that the terminal distal end of the wire isapproximately even with the proximal end of the band before applying thebonding agent.

Although some embodiments comprise both a band 114 and a bonding agent116, some embodiments comprise a band 114 without a bonding agent 116,and some embodiments comprise a bonding agent 116 without a band 114.Some embodiments can omit both a band and a bonding agent. For example,a manipulation member 104 and an endovascular device 102 can beintegrally formed in some embodiments. For another example, amanipulation member 104 separately formed from an endovascular device102 can be attached to the endovascular device without use of a band orbonding agent.

Various methods axe available for bending the wire 118 prior toattachment to the endovascular device 102. For example, the wire can bebent around a fixed mandrel. However, bending the wire around a fixedmandrel may yield inconsistent results and may damage wire byintroducing surface cracks that reduce the tensile strength of the wire.Likewise, manual bending of the wire may likewise yield inconsistentresults and may damage the wire by introducing substantial surfacecracks. For another example, a bend in the wire and may be heat set.However, heat setting may require more time than other bending methodsand may adversely affect other portions of the manipulation member 104.For example, if the manipulation member includes tubes 122 comprisingpolymers or other heat sensitive materials, heat setting may damagethose portions of the wire. These and other methods may be used to bendwires comprising stainless steel, nickel titanium alloys, or othermetals.

In some embodiments, the wire 118 can be bent quickly, reliably, andrepeatably without introducing any substantial surface crack at the bendby using a bending device 150, as illustrated in the examples of FIGS.14 and 15, comprising a blade or punch 152 and a flexible die 154. Thebending device 150 may further comprise a backgauge 156, a positionguide 158, an actuating mechanism 160, and a base 162. The die 154, thebackgauge 156, and the position guide 158 can be directly or indirectlyattached to the base 162. The blade 152 can be connected to the base 162by the actuating mechanism 160.

The wire 118 can be positioned between the blade 152 and the die 154,and the blade can press the wire into the die to form a bend having aninternal radius that matches an external radius of an edge 164 of theblade. As the blade 152 presses the wire 118 against the die 154, thedie resiliently deforms and urges portions of the wire on opposing sidesof the blade in a direction opposite a direction of the blade'smovement. The angle of the resulting bend will depend upon the distancethe blade moves toward the pad after the wire is engaged by both theblade and die.

In some embodiments, the edge 164 of the blade 152 can have a radiusthat is between one half and three times a diameter of the wire 118 at alocation under the center of the edge while the bending device 150 bendsthe wire 118. In some embodiments, the radius of the edge 164 isapproximately equal to the diameter of the wire at that location.

The blade of 152 can be formed of a material that is substantiallyharder and has a greater compressive yield strength than the material ofthe wire 118. On the other hand, the die 154 can be formed of a materialthat is substantially less hard than the material of the wire 118, andelastically and resiliently deforms as the wire is pressed into the dieby the blade. For example, in embodiments wherein the wire is formed ofnickel titanium alloy, the blade can be formed of stainless steel andthe die 154 can be formed of polyurethane.

The position guide 158 can be configured to orient the wire 118 relativeto the edge 164 of the blade 152. For example, the guide 158 cancomprise a pair of surfaces 166 that are oriented to form a V-shapedtrough that orients the wire. In some embodiments, a longitudinal axisof the wire can be oriented substantially perpendicularly to the edge164.

The backgauge 156 can comprise a surface 168 that acts as a hard stop toa distal end of the wire 118 extending in the position guide 158. Thesurface 168 can be spaced from a plane 170 (FIG. 15) defined by movementof the edge 164 of the blade 152 during operation of the bending device150. When the wire is positioned in the guide 158 with the distal end ofthe wire of abutting the surface 168, the distance X between the plane170 and the surface 168 will correspond to the distance between thedistal end of the wire and the center of the bend. Thus, the backgauge156 can reliably position the bend along the wire 118. Reliablepositioning of the bend along the wire can be particularly advantageouswhen bending a tapered wire. For example, positioning of the bend at alocation where the wire has a particular diameter may be desired.

The actuating mechanism 160 can be attached to the base 162 by a frame172. The actuating mechanism can comprise a mechanical, pneumatic,hydraulic, or servo-electric system for applying force to the blade indirections toward and away from the die 154. For example, the actuatingmechanism 160 can comprise a lever mechanism to move the blade inresponse to manual operation of a handle 174. In some embodiments, anangle of the bend produced by operation of the bending device 150 can becontrolled by limiting a distance of movement of the blade 152 by theactuating mechanism 160.

The connection 106 can substantially permanently couple the endovasculardevice 102 and manipulation member 104 during use of the assembly 100for endovascular intervention. For example, the connection 106 cancouple the endovascular device manipulation member during insertion ofthe endovascular device into a blood vessel, e.g., a cerebral bloodvessel, using the manipulation member, manipulation of the endovasculardevice to perform a therapy within the blood vessel, and removal of theendovascular device from the blood vessel using the manipulation member.In some embodiments, the assembly 100 can be inserted through amicrocatheter. The endovascular device can be removed from the bloodvessel in some embodiments by proximally pulling the manipulationmember, for example to retract the endovascular device into amicrocatheter. The endovascular device can be deployed in someembodiments by maintaining a location of the endovascular device whileretracting the microcatheter from over the endovascular device.

With reference to FIGS. 16-20, the assembly 100, including themanipulation member 104 and endovascular device 102, can be used as aflow restoration device. For example, the endovascular device cancomprise a self-expanding member used to restore blood flow in a medicalpatient experiencing ischemic stroke due to large intracranial vesselocculusion. In a preferred arrangement, the assembly 100 can be used inconjunction with a microcatheter 108. The assembly 100 can retrievethrombi from highly tortuous, small, and thin wall vessels. The assembly100 can be used to treat vessels with diameters, for example, rangingfrom 2.0 mm to 5.5 mm, such as the internal carotid artery, M1 and M2segments of the middle cerebral artery, anterior cerebral artery,basilar artery and vertebral artery, though other ranges, sizes, andparticular vessels are also possible.

During a flow restoration procedure, a balloon guide catheter (notshown) can be moved through the vasculature towards a treatment area. Aballoon, located on a distal end of the balloon guide catheter, can beexpanded against the walls of a blood vessel 176. The microcatheter 108can first be delivered through the balloon guide catheter. Theendovascular device 102 can then be delivered through the microcatheter108. Alternatively, the endovascular device 102 can be delivered withthe microcatheter 108. The endovascular device 102 can be in avolume-reduced form within the microcatheter 108. The microcatheter 108can be advanced through the vessel 176 and placed adjacent a thrombus178. The endovascular device 102 can be positioned such that theconnection 106 is upstream of the thrombus 178, a distal end of theendovascular device is downstream of the thrombus, and a portion of theendovascular device 102 is located radially adjacent to the thrombus178. In a preferred arrangement illustrated in FIG. 17, themicrocatheter 108 can be placed alongside the thrombus 178 such that adistal tip 180 of the microcatheter 108 is beyond the thrombus 178,wherein the distal tip 180 is from greater than about 0 mm to about 10mm or more, or about 3 mm to about 5 mm beyond the thrombus 178, thoughother ranges and values are also possible. In a preferred arrangement,the endovascular device 102 can be positioned such that portions of theendovascular device 102 extend both proximally and distally of thrombus178.

As illustrated in FIG. 18, the endovascular device 102 can be held in afixed position by holding the manipulation member 104 stationary whilethe microcatheter 108 is withdrawn (i.e., pulled proximally). As themicrocatheter is withdrawn, the endovascular device 102 can be releasedfrom its volume-reduced form, and can expand. The endovascular device102 can assume at least a portion of its unconstrained form, therebyexpanding to bring at least part of the endovascular device 120 intopenetrating contact with the thrombus 178. If the position of theendovascular device 102 needs to be adjusted, the manipulation member104 and/or microcatheter 108 can be moved together or individually, andif necessary, the endovascular device 102 can be placed back in themicrocatheter and then expanded again, or redeployed.

Once deployed, the endovascular device 102 can exert an outward radialforce on the thrombus 178, as described above, thus reducing thecross-sectional area of the thrombus 178, forming a channel forimmediately re-establishing at least partial blood flow through theblood vessel 176 past the thrombus 178, and/or loosening the thrombusfrom the vessel wall. In some embodiments, for example, about 10% toabout 60% of the original thrombus 178 circumference can be separatedfrom the vessel wall after the endovascular device 102 is deployed, andthe ability of the thrombus 178 to hang onto the vessel wall viaadhesion and friction can accordingly be reduced. In some embodiments,the cross sectional area of the thrombus 178 can be significantlyreduced by the deployed endovascular device 102, resulting in a thrombus178 having about 30% to about 95% of its original cross sectional area,but more typically about 50% to about 80% of its originalcross-sectional area. In some embodiments, administration of aneffective amount of a clot-busting drug, such as, for example tissueplasminogen activator (tPA), to the site of the thrombus 178 can furtherbe applied during the blood flow restoration procedure to enhancedissolution of the thrombus 178. In some embodiments, the open channelcreated by the endovascular device 102 can increase the exposed surfacearea of the thrombus 178, thereby facilitating faster dissolution of thethrombus 178 with such clot-busting drugs.

With reference to FIGS. 19 and 20, once the endovascular device 102 hasengaged and captured the thrombus 178, the thrombus 178 can be removed.Prior to pulling back on the manipulation member 104, the microcatheter108 can be manipulated. For example, the microcatheter 108 can be movedforward to a predetermined point relative to the endovascular device102. Use of markers along the microcatheter 108 and/or endovasculardevice 102 can be used to determine the relative locations of themicrocatheter 108 and endovascular device 102. For example, themicrocatheter 108 can be moved distally until it covers the band 114.The microcatheter 108 and endovascular device 102 can then be removedtogether. Description of the use of such markers can be found, forexample, in PCT Publication No. WO 2009/105710, which is incorporated byreference in its entirety.

With reference to FIG. 20, during retrieval of the assembly 100 andthrombus 178, the initial channel created for flow restoration throughor past the thrombus 178 can remain open. The balloon can remaininflated to provide for maximum proximal flow control. For example, insome embodiments the balloon can ensure that there is no flow proximallythrough the vessel from the balloon towards the endovascular device 102.As part of the retrieval procedure, continuous aspiration can beemployed through the balloon guide catheter with vigorous aspirationwhen the endovascular device 102 is near a distal tip of the balloonguide catheter. Aspiration assistance can enable flow reversal throughthe endovascular device 102 and thrombus 178. The aspiration with flowreversal can help allow the distal vasculature to continue to have bloodperfusion through the vessels during the retrieval process and caninhibit the possibility of distal emboli. There can be an advantage tohaving blood flow across the self-expanding device 102 and thrombus 178with the potential of natural lysing of blood and increased surface areafor thrombus dissolving medicines, if they are provided. The aspirationwith flow reversal can also assist in the thrombus retrieval process byaiding in the removal of the thrombus 178. The flow can be directedtowards the lumen of the balloon guide catheter due to the aspiration.The endovascular device 102 and thrombus 178 can thus be assisted by theflow to enter the lumen of the balloon guide catheter. In someembodiments, if withdrawal into the balloon guide catheter is difficultfor any reason during aspiration, the balloon can be deflated, and theballoon guide catheter, microcatheter 108, and the assembly 100 can bewithdrawn simultaneously as a unit while maintaining aspiration.

In some embodiments, assembly 100 can be used as a device for use as animplantable member (e.g., stent). For example, the manipulation member104 and endovascular device 102, coupled at the connection 106, can bedelivered through a microcatheter 108 to a treatment site such as astenosis or aneurysm. Similar to the method described above, themicrocatheter can be withdrawn, and the endovascular device 102 canexpand against a vessel wall. Similar to use as a flow restorationdevice, if necessary, the endovascular device 102 can be repositioned ifit is not place correctly on a first attempt. Once the endovasculardevice 102 is in a desired location at the treatment site, theendovascular device 102 can then be detached from the manipulationmember 104 and be used as an implantable member.

A phrase such as “an aspect” does not imply that such aspect isessential to the subject technology or that such aspect applies to allconfigurations of the subject technology. A disclosure relating to anaspect may apply to all configurations, or one or more configurations.An aspect may provide one or more examples of the disclosure. A phrasesuch as “an aspect” may refer to one or more aspects and vice versa. Aphrase such as “an embodiment” does not imply that such embodiment isessential to the subject technology or that such embodiment applies toall configurations of the subject technology. A disclosure relating toan embodiment may apply to all embodiments, or one or more embodiments.An embodiment may provide one or more examples of the disclosure. Aphrase such “an embodiment” may refer to one or more embodiments andvice versa. A phrase such as “a configuration” does not imply that suchconfiguration is essential to the subject technology or that suchconfiguration applies to all configurations of the subject technology. Adisclosure relating to a configuration may apply to all configurations,or one or more configurations. A configuration may provide one or moreexamples of the disclosure. A phrase such as “a configuration” may referto one or more configurations and vise versa.

The foregoing description is provided to enable a person skilled in theart to practice the various configurations described herein. While thesubject technology has been particularly described with reference to thevarious figures and configurations, it should be understood that theseare for illustration purposes only and should not be taken as limitingthe scope of the subject technology.

There may be many other ways to implement the subject technology.Various functions and elements described herein may be partitioneddifferently from those shown without departing from the scope of thesubject technology. Various modifications to these configurations willbe readily apparent to those skilled in the art, and generic principlesdefined herein may be applied to other configurations. Thus, manychanges and modifications may be made to the subject technology, by onehaving ordinary skill in the art, without departing from the scope ofthe subject technology.

It is understood that the specific order or hierarchy of steps in theprocesses disclosed is an illustration of exemplary approaches. Basedupon design preferences, it is understood that the specific order orhierarchy of steps in the processes may be rearranged. Some of the stepsmay be performed simultaneously. The accompanying method claims presentelements of the various steps in a sample order, and are not meant to belimited to the specific order or hierarchy presented.

As used herein, the phrase “at least one of” preceding a series ofitems, with the term “and” or “or” to separate any of the items,modifies the list as a whole, rather than each member of the list (i.e.,each item). The phrase “at least one of” does not require selection ofat least one of each item listed; rather, the phrase allows a meaningthat includes at least one of any one of the items, and/or at least oneof any combination of the items, and/or at least one of each of theitems. By way of example, the phrases “at least one of A, B, and C” or“at least one of A, B, or C” each refer to only A, only B, or only C;any combination of A, B, and C; and/or at least one of each of A, B, andC.

Terms such as “top,” “bottom,” “front,” “rear” and the like as used inthis disclosure should be understood as referring to an arbitrary frameof reference, rather than to the ordinary gravitational frame ofreference. Thus, a top surface, a bottom surface, a front surface, and arear surface may extend upwardly, downwardly, diagonally, orhorizontally in a gravitational frame of reference.

Furthermore, to the extent that the term “include,” “have,” or the likeis used in the description or the claims, such term is intended to beinclusive in a manner similar to the term “comprise” as “comprise” isinterpreted when employed as a transitional word in a claim.

The word “exemplary” is used herein to mean “serving as an example,instance, or illustration.” Any embodiment described herein as“exemplary” is not necessarily to be construed as preferred oradvantageous over other embodiments.

A reference to an element in the singular is not intended to mean “oneand only one” unless specifically stated, but rather “one or more.”Pronouns in the masculine (e.g., his) include the feminine and neutergender (e.g., her and its) and vice versa. The term “some” refers to oneor more. Underlined and/or italicized headings and subheadings are usedfor convenience only, do not limit the subject technology, and are notreferred to in connection with the interpretation of the description ofthe subject technology. All structural and functional equivalents to theelements of the various configurations described throughout thisdisclosure that are known or later come to be known to those of ordinaryskill in the art are expressly incorporated herein by reference andintended to be encompassed by the subject technology. Moreover, nothingdisclosed herein is intended to be dedicated to the public regardless ofwhether such disclosure is explicitly recited in the above description.

While certain aspects and embodiments of the subject technology havebeen described, these have been presented by way of example only, andare not intended to limit the scope of the subject technology. Indeed,the novel methods and systems described herein may be embodied in avariety of other forms without departing from the spirit thereof. Theaccompanying claims and their equivalents are intended to cover suchforms or modifications as would fall within the scope and spirit of thesubject technology.

What is claimed is:
 1. A device for intravascular intervention, thedevice comprising: an intervention element comprising a proximal portionand an opening through the proximal portion, the proximal portioncomprising a proximal part and a middle part, the proximal partpositioned proximally of the opening, and the middle part positionedbetween the proximal part and all of the opening; an elongatemanipulation member comprising a hooked portion extending about theproximal portion of the intervention element and positioned such thatthe proximal part underlies a portion of the elongate manipulationmember and the entire middle part does not underlie the elongatemanipulation member; and a joining element permanently attaching thehooked portion to the intervention element.
 2. The device of claim 1,wherein the joining element comprises a band that substantiallysurrounds at least a section of the elongate member and a segment of theintervention element.
 3. The device of claim 1, further comprising abinding agent engaging each of the intervention element, the elongatemember, and the joining element.
 4. The device of claim 3, wherein thebinding agent is a UV curable adhesive.
 5. A device for intravascularintervention, the device comprising: an elongate manipulation membercomprising a distally-located attachment portion, the attachment portioncomprising a first segment, a second segment, and a bend between thefirst and second segments; an intervention element comprising a proximalend portion and a hole through the proximal end portion, the attachmentportion of the elongate member extending through the hole at the bendsuch that the first segment and the second segment are located ondifferent sides of the proximal end portion, the proximal end portioncomprising a retention portion (a) positioned between all of the holeand a terminal proximal end of the intervention element and (b)laterally offset from the attachment portion, the retention portioncomprising a proximal part and a middle part, the middle part beinglocated between the proximal part and all of the hole, and the proximalpart having a width greater than a width of the middle part, theintervention element being permanently attached to the elongatemanipulation member.
 6. The device of claim 5, further comprising aband, wherein the band substantially surrounds at least a section of theattachment portion of the elongate member and a segment of the proximalportion of the intervention element.
 7. The device of claim 6, whereinthe band has an inner diameter that is less than a width of the proximalend portion of the intervention element.
 8. The device of claim 6,wherein the band does not extend over the hole.
 9. The device of claim6, wherein the band is crimped onto each of the elongate member and theintervention element.
 10. The device of claim 9, wherein the band iscrimped onto the retention portion of the intervention element.
 11. Thedevice of claim 9, wherein the proximal end portion of the interventionelement comprises a shoulder positioned laterally of the retentionportion, the shoulder extending laterally to an extent, measured fromthe retention portion, that is greater than or equal to a wall thicknessthe band.
 12. The device of claim 9, wherein the proximal end portion ofthe intervention element has a top side and a bottom side, the holeextends through the proximal end portion between the top side and thebottom side, and the retention portion extends laterally beyond theattachment portion of the elongate member as viewed from the top. 13.The device of claim 12, wherein, as viewed from the top of the proximalend portion of the intervention element, the retention portion islaterally offset from the attachment portion of elongate member.
 14. Thedevice of claim 13, wherein, as viewed from the top of the proximal endportion of the intervention element, the proximal part of the retentionportion underlies the attachment portion of elongate member and themiddle part of the retention portion does not underlie the attachmentportion.
 15. The device of claim 14, wherein at least one of the firstsegment or the second segment of the elongate member has an extendingportion that extends into a region that is (i) between the top side andthe bottom side of the proximal end portion, and (ii) between theproximal part of the retention portion and the hole, the extendingportion and the proximal part being aligned such that a line extendingin a proximal-distal direction intersects the extending portion and theproximal part.
 16. The device of claim 6, wherein the band iscircumferentially continuous.
 17. The device of claim 6, wherein theband is radiopaque.
 18. The device of claim 6, wherein the band iscircumferentially discontinuous and comprises first and second lateraledges, the band having first and second portions adjacent the first andsecond edges, respectively, that overlap each other.
 19. The device ofclaim 5, further comprising a binding agent attached to the elongatemember and the intervention element.
 20. The device of claim 19, furthercomprising a band, wherein the band substantially surrounds the distalportion of the elongate member and a portion of the proximal end of theintervention element.
 21. The device of claim 19, wherein the bindingagent comprises an adhesive.
 22. The device of claim 21, wherein theadhesive is UV curable.
 23. The device of claim 5, wherein the firstsegment and the second segment extend generally parallel to each other.24. The device of claim 23, wherein the elongate manipulation memberfurther comprises a proximal terminal end and a distal terminal end, andthe distal terminal end is proximal of the bend of the attachmentportion.